From the Guidelines
A person on semaglutide may need metoclopramide to manage severe nausea and vomiting that can occur as side effects of semaglutide therapy, particularly if these symptoms are indicative of gastroparesis or excessive slowing of stomach emptying. Semaglutide works by slowing gastric emptying and reducing appetite, which helps with weight loss and blood sugar control, as evidenced by its efficacy in achieving significant total body weight loss (TBWL) in clinical trials 1. However, this slowing of stomach emptying can sometimes become excessive, leading to gastroparesis symptoms including nausea, vomiting, early satiety, and abdominal discomfort. Metoclopramide is a prokinetic medication that increases the rate of gastric emptying by enhancing muscle contractions in the upper digestive tract and can help counteract these effects. The typical dosage is 5-10 mg taken 30 minutes before meals and at bedtime, though treatment should generally be limited to 12 weeks or less due to the risk of tardive dyskinesia with prolonged use, as recommended by the FDA 1. Some key points to consider when using metoclopramide for symptom management in patients on semaglutide include:
- The potential for metoclopramide to partially counteract the appetite-suppressing effects of semaglutide, potentially affecting weight loss outcomes 1
- The importance of weighing the benefits of metoclopramide against its potential risks, particularly in patients with a history of extrapyramidal disorders or other conditions that may be exacerbated by the medication 1
- The availability of alternative treatment options for gastroparesis, such as domperidone (available outside the U.S.) and erythromycin, which may be considered in patients who are unresponsive to or intolerant of metoclopramide 1. It is also worth noting that GLP-1 receptor agonists like semaglutide have been associated with a range of benefits beyond weight loss and blood sugar control, including reduced risk of major adverse cardiovascular events (MACE) and slowed decline in eGFR in patients with chronic kidney disease (CKD) 1. Therefore, the decision to use metoclopramide in a patient on semaglutide should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and treatment goals.
From the FDA Drug Label
Semaglutide causes a delay of early postprandial gastric emptying, thereby reducing the rate at which glucose appears in the circulation postprandially.
A person on semaglutide may need metoclopramide because semaglutide delays gastric emptying, which can cause gastrointestinal side effects such as nausea and vomiting. Metoclopramide is a medication that can help accelerate gastric emptying and alleviate these symptoms. 2
From the Research
Gastrointestinal Side Effects of Semaglutide
- Semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1RA), is known to cause gastrointestinal side effects, including nausea, diarrhea, and vomiting 3, 4, 5.
- These side effects are commonly reported by patients taking semaglutide, and they can be severe enough to affect the patient's quality of life.
Use of Metoclopramide
- Metoclopramide is a medication that is used to treat gastrointestinal disorders, including gastroparesis and nausea 6, 7.
- It works by increasing the movement of the stomach and intestines, and it can also help to reduce nausea and vomiting.
- In the context of semaglutide treatment, metoclopramide may be used to help manage gastrointestinal side effects, such as nausea and vomiting.
Rationale for Using Metoclopramide with Semaglutide
- The use of metoclopramide with semaglutide may be justified in patients who experience severe gastrointestinal side effects, such as nausea and vomiting 6, 7.
- Metoclopramide can help to reduce the severity of these side effects, making it easier for patients to tolerate semaglutide treatment.
- However, it is essential to weigh the benefits of using metoclopramide against the potential risks, including the risk of tardive dyskinesia, a movement disorder that can be irreversible 6.